Job Description

Job Title: Denials Specialist (Remote)

Pay Rate: $22.47/hour

Assignment Length: 6-12 months (with potential to extend or convert)

Shifts Available:

Shift 1 : 1 -10 pm CST Tuesday-Saturday. Training required during standard business hours.

Shift 2: 8-5pm CST Tuesday - Saturday. Training required during standard business hours .

Shift 3: 1-10 pm CST Sunday-Thursday. Training required during standard business hours.

Shift 4: 8-5pm CST Monday-Friday. Training required during standard business hours.

Shift 5: 8-5pm CST Sunday-Thursday. Training required during standard business hours.

Position Overview

This role is responsible for generating, processing, and maintaining provider and member correspondence related to preservice and concurrent reviews. The position supports denial communications by accurately producing letters from medical documentation while meeting regulatory timelines and quality standards.

This is a non-member-facing, independent role that requires strong attention to detail, written communication skills, and comfort working across multiple systems.

Key Responsibilities

• Generate and process denial and authorization correspondence using EMR documentation
• Ensure all correspondence is completed accurately and within required turnaround times
• Maintain and update correspondence templates based on regulatory and internal requirements
• Support data tracking and reporting related to the denial process
• Assist with monitoring correspondence turnaround times
• Perform additional administrative tasks as assigned

Performance Expectations

• Complete an average of 4 letters per hour
• Maintain 95% accuracy , including grammar and punctuation
• Meet turnaround time requirements based on line of business
• Work independently while prioritizing time-sensitive tasks

Required Qualifications

• High School Diploma or GED
• 1 2 years of related healthcare or administrative experience
• Strong written English skills (accuracy and punctuation are critical)
• Basic knowledge of medical terminology
• Advanced computer skills and ability to work in multiple systems simultaneously

Preferred Qualifications

• Experience with denials, appeals, or utilization management
• Background as a CNA, CMA, Radiology Tech, Sonography Tech, or Coding Certification
• Familiarity with EMR systems and medical documentation

Tools & Systems Used

• TruCare
• Microsoft Excel, Word, Outlook, Teams
• OneDrive and OneNote
• Faxing and document management tools

Additional Notes

• Role does not involve direct interaction with members or providers
• Typing accuracy of 90% or higher is required (speed is less important than accuracy)
• Candidates with only call center experience may not be a fit

CLIENT does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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